December 1,2014

22:07
It's a hard life, but someone has to do it.

I'm writing from frigid Chicago, where the air temperature is something around 20 degrees, and the wind chill is 50 below numbness. I'm here for the 100th Anniversary Edition of RSNA, and one must brave adverse conditions to attend so momentous an occasion.

If you are reading my illustrious blog, you must have some connection to radiology, and thus you've probably attended RSNA at least once. If so, you know that the most important part of the whole meeting is the parties that come after hours. In years past, the big vendors have put on some really incredible soirees, with open bars and buffets overflowing with prime rib and other expensive delicacies. 

Then came the economic bust, and the parties became fewer and further between.  But this year, there seem to be a few more than I've seen recently. In fact, I received about four invitations for tonight alone. Fortunately, the decision as to which to attend was quite easy. Zotec, our billing company, delivered the most incredible RSNA experience I've ever, well, experienced: An evening with former President George W. Bush in the Grand Ballroom of the Trump Hotel. 

Zotec is apparently doing quite well; the teaser on the video screens behind the homey staging with two armchairs touted the processing of $1 Billion in charges. I'm not sure what the average percentage of their fees might be, but if we assume even a low 7%, the Law Brothers who run the company are raking in $70M. Not too shabby in this day and age. 

Anyway, as a very good Zotec customer, Mrs. Dalai and I, as well as one of my former partners/new bosses were invited not only to the event, but to a photo-op with Mr. Bush as well. We arrived early, donned our wrist-bands, and queued up for our few seconds with the Man. We were most amused by the Secret Service agents with somewhat ill-fitting suits and earphones scoping out the crowd of mostly older docs and their wives. 

When our turn for the photo came, the President turned and greeted us, and put his arm around Mrs. Dalai and I, and we all smiled for the camera. (I'll post it when it arrives in the mail.) In the process, I said, "Mr. President, we miss you dearly," to which he chuckled, and Mrs. Dalai followed up with "Can we get you back?" W chuckled again and shook his head. "I'd be going back alone!" To which we responded, "You would still have a lot of support." We said our goodbyes, and proceeded on to the Trump Grand Ballroom (which wasn't all that large...someone needs to be fired) where the armchair talk shortly commenced.  

The format was informal, with Scott Law, Zotec CEO, sitting adjacent to the President on the stage. Mr. Law would ask a question, and Mr. Bush would answer, to enthusiastic applause. I won't try to reproduce the conversation, but several observations are in order. First and foremost, W is a witty, humble, and eloquent (yes, I said eloquent!) speaker. Over the course of the hour, we laughed and (almost) cried with him. We were taken to the heart of the Oval Office, Ground Zero, and the classroom in Florida where Mr. Bush was informed of the 9/11 attacks. In all of these scenarios, Mr. Bush conveyed a sense of duty to his country, humility in face of unimaginable responsibility, and fierce devotion to the defense of the nation he led for eight years. His goal after hearing of the airliners hitting the World Trade Center buildings and the Pentagon, was personified as the protection of the little girl who was reading a story to him that fateful morning. 

Having heard President Clinton speak at RSNA a few years back, I was struck by the huge discrepancy in the perception versus the reality of both men. Mr. Clinton, whom some think the greatest President ever, spoke in a disjointed manner, and spent much of the talk tooting his own horn about how much he had been doing for the poor in Third-World nations, and chastising us rich doctors to help. Mr. Bush, on the other hand, was witty, humble when the moment called for it, and proud when appropriate. And he spoke very clearly, very articulately, and again, eloquently. Those who have developed a visceral hatred of the man won't want to hear it, but W may well have been the most honest, loyal, and capable man to occupy the office in a very, very long time. He was labeled a "cowboy" and "stupid" by a media and a Leftist bunch that couldn't stand the fact that he didn't act like their vision of a Harvard-trained leader (he did receive an MBA from the Harvard Business School). For your information, President Bush used the word "strategy" about a dozen times, and he pronounced it properly. 

I thank Zotec for giving us the opportunity to see how someone with character behaves when given the greatest and hardest task known, in contrast to what we have seen on the news daily for the past several years. I am humbled and honored to have been in the presence of a truly great man. 

And I should also thank Zotec for doing a damn good job with our billing!
18:02
There is a touch of melancholy for me here at RSNA 2014 to go with the 20 degree nip in the air. I'm not one to dwell much on the deep meanings of beginings and endings, but while strolling the exhibits today, I realized that I've been attending this monster of a convention on and off since I was a Nuclear Medicine Fellow in 1990. And it occurs to me that since I'm now semi-retired, it is possible that I won't return next year. But we'll see how that goes.

One of the joys of RSNA, and my fame, or at least notariety in the field, is the chance to meet up with those far more promienent in the field than I. Hence the title of this piece. I had the wonderful opportunity to share a cappuchino with two giants of PACS, Mike Cannavo and Dr. David Clunie. Mike I've known for years, but I had only communicated via email and AuntMinnie forums with David. I was very fortunate to get both of them together on the same couch for a few moments today. These two gentlemen have been involved in the business since before anyone could even spell PACS. They both have an amazing level of knowledge, not to mention various documentation, of those early days, and I'm urging them to collaborate on a book.  Maybe I would qualify for a footnote...

I am occasionally accosted, I mean greeted, by some of my loyal readers. In fact, when I stopped at one booth to say hello, a friend who was mentioned in an earlier post and was apparently embarassed by the fact that it proves he's one of my readers spotted me and exclaimed, "It's the Dalai! Shall I kiss your ring? Shall I kiss your ass?" To which I replied, "Not unless someone gets it on camera!"

Today was my informatics day, and I heard some talks about portable platforms, and SOA's, and image sharing. SOA's, aka Service Oriented Architecture, as presented by Dr. Paul Chang  are fascinating constructs with huge potential. Dr. Chang showed an example from U of C wherein the SOA determines if the patient has appropriate labs ordered, and if not, it initiates the order to acquire them. So much for us humans.

I also stopped by a booth or two.  (This is starting to sound like a third-grader's rendition of his trip to Disney World, but for me, that's quite appropriate.)

In my feeble-minded semi-retired state, I've decided not to continue my practice of posting every last little detail about demos and things. You really have to get your own hands on the software (well, the keyboard and mouse, but you know what I mean) to determine if something will work for you or not.  I do pride myself on attempting to wear multiple hats when I evaluate a program, which I think is the key to my success as my group's CTO as well as the premier radiologist PACS blogger (still the only one, but I'll take it).  I'd like to think I can make any commercial PACS client work; that's my ex-engineer hat in action. But I think I'm reasonably good as well at figuring out if something will work for my least-technically-savvy former partner, the one who calls from airplanes wanting to know how to adjust the volume on his laptop. So, in my new, lazier, partially-retired personna, I'm just going to sketch out the very basics and leave the picayune details for another time.

Here we go. I stopped at TeraRecon, and had a look at their latest offering, deconstructed PACS, which basically utilizes TR as a PACS overlay, uniting data from multiple data silos (coming from the Midwest I'm not used to anything other than corn and grain being stored in silos) and adding in the magic of advanced processing for a sort of super enterprise PACS.  From what I could see, there are still a few details to be worked out before the ssytem will work as I would want it to, but the TR folks are on their way. Ultimately, the overlay will require the ability to check for priors in all the silos (which they seem to have almost mastered) and be able to talk back and forth to the underlying PACS to manage workflow, which seems to be on its way. I was most amused and honored to be treated with equal deference to the chairman of a very well-known radiology department who was there at the time. The chairman had actually heard my Laws of PACS talk a while back, and urged me to keep up the good fight. And so I shall.

To be scrupulously fair, Visage has a similar approach to overlying PACS with an advanced imaging platform, but I ran out of time before I could see their latest. Apologies to Sam and Brad. I'll look at it ASAP. ***

I should break off into a separate post, but the following entry will be fairly short.

About three weeks ago, Agfa placed a test version of IMPAX 7 Agility PACS in our reading room, and I was able to have a few hours of playtime with it. I had promised not to report anything until talking with the important people at Agfa, and I usually honor my promises.  As a followup to the home test, I met with some Very important people in a spartan back room of the lavish Agfa booth. You would think that Agfa would not be happy with me, given the rather brutal treatment I've given them over the years. You would be wrong. Agfa has always been gracious in accepting my acerbic criticism and improving where possible. Agility is no exception, save the fact that I didn't really have to criticize as much as usual. Gone (FINALLY) is the tool-toggling I've whined about for years.  Available (FINALLY) is workable user-level hanging protocol creation. And so on. I had some complaints/observations about the way the latter worked, and some of my ideas had already been incorporated between my two recent exposures, and others hopefully will appear soon. There is very tight integration with the "top three" vendors of things like advanced processing and nuclear medicine. For example, my Segami Oasis will come up within the PACS viewport as if it were part of the PACS itself. For better or worse, the port basically reverts to the incoming programing, mouse-controls and all. Could there be a more unified approach to this? I'll have to play some more. Agfa has utilized hot-spots on the image for common controls like window-level, an approach I'm not fond of, for what that's worth.

Agility is considerably different than IMPAX 6 (once code-named Odyssey). It is a worthy successor, and frankly is somewhat more mainstream in operation and appearance than 6. When asked how I would grade it, I said that with the current improvements, I would give it a B+/A-. It has a way to go, but it does represent a significant step in the right direction.

As always, more to come!

*** ADDENDUM!!

I wandered by the Visage booth on my way back to the educational sessions from my $20 mediocre lunch, and I stopped to see my good friend Brad. Given the 10 minutes I could spare, he and the apps folks managed to give me a quick but thorough view of the latest version. It is impressive, all the more so to realize that the system operates with server-side rendering. This allows platform neutrality (it will run on my Mac, iPad, etc.) and really rapid loading of huge datasets since they don't actually go anywhere. Visage has outfitted a Very large healthcare operation with its version of a Deconstructed PACS, operated from a single main server (of course with failover backup) and six rendering servers. Brad tells me this configuration can handle tens of millions of images and hundreds of simultaneous users and still be at only 20% of its capacity. 

Visage has some very nice features such as a lesion marking function that gives volumetric information as well as orthoganal dimensions, nice for RECIST reporting. In its PACS implementation, Visage can dive into silos and match exams, and has a better hanging protocol than a new PACS version I've examined recently. It can handle all modalities, and even can produce MIPS from breast tomosynthesis, something I haven't seen before, altough it won't make me want to start back reading mammograms.  There is of course very powerful advanced imaging as well. 

I do have to point out two deficiencies, which Brad tells me nicely are only problematic for old, senile vacuum-tube loving knuckle draggers like myself (OK, he didn't say it that way, but I don't want you to think I have any sort of elevated opinion of myself). First, the level of automation of things like coronary vessel segmentation is limited. Visage's philosophy is that automated detection is not perfect, and the human eye may better detect a more aberrant vessel path. That's probably true, but I do like the joy of one button operation. (Anyone remember the line from the Lost in Space Movie where Major West launches the Jupiter 2 by saying "...And the monkey flips the switch...")

Secondly, this deconstructed PACS is designed to be driven by an EMR/EHR, speech recognition, RIS, etc. What Visage has declined to provide, and Brad says I don't need, is a worklist! Here we disagree. I come from a PACS driven workflow shop, and I like it that way. Apparently there are third parties who can provide a worklist, but I still think Visage should write their own. I'll be glad to help. 

And to my friends at Merge, please don't worry about the omission of your booth. I walked by a few times and you have all been very busy, hopefully with paying customers. I promise to review the updated PACS and other offerings online with you at a later date. Two days at RSNA is just not enough!!

November 5,2014

15:36
Dalai's note:  My rather vocal presentation of my views on medical IT have earned me an international speaking career. It is sad to see that nothing much has changed over all the time I've been blogging and speaking on this issue. In fact, even though it is more ubiquitous, medical software remains as useless and confounding as ever. It is gratifying, however, to see others take up the cause of improving this potentially deadly deficit. As cross-published on KevinMD.com, this piece from Dr.  James Salwitz, an oncologist who blogs on SunriseRounds.com, takes a similar approach to lambast those who dump their (soft)wares on an unsuspecting medical community.

A 57-year-old doctor I know is retiring to teach at a local junior college. He is respected, enjoys practicing medicine and is beloved by his patients; therefore, I was surprised. While he is frustrated by the complexity of health insurance, tired by the long hours and angered by defensive medicine, the final straw is that he can not stand the world of the EMR.

As an Electronic Medical Record junkie, I would quit if I had to practice without a computerized information system. These programs are a dramatic improvement over the paper and pen way of keeping records. Still, I understand the onerous problems. Data entry is clumsy, painful and takes hours. Information is stored in a nearly random manner, not much better than papers tossed into a cardboard box. Every EMR program is different and none share vital patient data. Training is lousy, access is non-intuitive, support is spotty, costs are high and any gains seem to be countered by poorly timed system crashes.

Unhappy to lose a physician from our medical community, I find myself musing about what has gone wrong with a critical technology that has such shining potential. Computer systems fly giant aircraft around the world without incident, handle trillions of dollars of financial trade without a penny lost and allow hundreds of millions to tweet, Facebook or blog. Why is medical IT so bad?

The major problem with EMRs, as they are conceived and as they presently exist, is that they are round pegs in square holes. They are designed to gather and store information; shiny electronic file cabinets, and they are built around the primary function of billing; grinding out ICD-9 and CPT codes. That would be fine if that was what doctors actually do with their time and if making money was the primary goal of practicing medicine. However, surprise, surprise, what doctors really do is treat patients. EMRs often hinder, not assist, the giving of medical care.

A physician’s normal function is to interface between objective biology and the complexity of each human life. Often called “the art” of medicine, it is the act of bridging science to individual reality. Ask questions; test; collect information. Attempt to organize by creating of a list of possibilities, a differential diagnosis. Assimilate, screen and sift that data until you reach a final diagnosis. Then, implement therapy using science and the results of research, with compassion, patience and the skill of a teacher.

A functional electronic health delivery system would assist in this systematic decision process, actively participating in the query and analysis, adding scientific knowledge and observations based on state-of-the art recommendations. Help the doctor build the differential. Recommend testing or therapeutic alternatives. The EMR should be aligned with the doctor’s goals, which are the patient’s health.

The GPS in my car is first rate. Data input is verbal and flawless. It tells speed, direction, and continuously adjusts recommendations based on my progress and traffic impediments. It even throws in alerts about the weather. In other words, the GPS not only stores data, it tells me what to do with it, and is constantly updated by events far beyond my windshield, which I have not yet considered. Someday soon, that GPS will actually drive my car.

A health computational system should have, at a minimum, the functionality of that GPS. Easy data entry and access. Flawless expanding storage. Clear output. Actionable recommendations and observations, based not only on the patient, but on the science of medicine. An EMR should be updated continuously by clinical information such as labs, vital signs and tests, as well as the most recent scientific discoveries, even if they are made halfway around the world, delivering at the bedside the vast resources of Big Data. Help me care for the patient by complementing my work.

As the practice of medicine becomes logarithmically more complex with the expanding potential of genomic or “Personalized Medicine,” advanced information technology will be vital. No doctor will be able to assimilate an individual patient’s genome and thousands of actionable variables into a differential diagnosis or comprehensive treatment. The key will be real-time EMR support.

To date no one has taken the potential or complexity of EMRs seriously. The assumption is that these systems can be built by cottage industries, with the result that there are hundreds of rudimentary programs, all grossly inadequate. The average GPS is far more functional.

This slowly expanding area of IT research is called translational bioinformatics, but there have been relatively few dollars invested by the NIH in the basic science. Data input remains primitive. We have no backbone on which to create a national network to maintain and track individual records. There is no integration with decision making software or connection to research troves. Medicine relies on the doctor to connect the myriad dots, even as he or she is up at midnight, typing elementary progress notes into elementary office systems.

Doctors need and desire help in taking care of their patients, but instead they have a tool designed for secretaries and insurance auditors. We must re-address the goals of clinical IT to improve, empower and give medical care. The future of our patients and the future of health, depend on it. No amount of frustration and burned out physicians will force patient lives into slots built for dollars.

December 8,2014

12:31

Join the #hcldr tweet chat tomorrow at 8:30 pm, ET, as HL7Standards.com contributor Leonard Kish moderates a chat on patient engagement.

Get full details on the chat in the post Do We Have Patient Engagement Backwards?, published on the Healthcare Leadership Blog.

The following topics will be discussed:

  • When does patient engagement become DIY health care? Will patients go around the hc system?
  • As tools & tech improve, what will we do for ourselves in 5 years and will no longer require visits to physician offices?
  • There are 20% who are #quantified selfers, there are 20% who may never engage, what is the most critical time for engagement of the other 60%?
  • What can we do about multi-morbidity, when people become overwhelmed with multiple chronic conditions and can no longer DIY?

And, if you haven’t already, be sure and download Leonard’s new, free, comprehensive patient engagement eBook, titled, “Patient Engagement is a Strategy, Not a Tool. How healthcare organizations can build true patient relationships that last a lifetime,” published right here on HL7Standards.com.

Categories: News and Views , All

December 4,2014

10:56

I’ve been having some Internet speed issues as of late, so I searched online and found a speed test. Turns out my download speed is a less than lightning fast at a mere 7.8Mbps – even though I pay for 24Mbps. I called up my Internet provider and had a conversation that went something like this:

Me: I am getting less than 8Mbps speed and I am paying for 24Mbps.

Customer “Service” Guy (CSG): What are you using the Internet for?

Me: Mostly email and online reading. No streaming videos or anything like that.

CSG: Sometimes the speed appears slower because of the websites you are on.

Me: OK…so how do I make it faster?

CSG: Would you like to upgrade your speed to 45Mbps?

Me: Only if I don’t have to pay more.

CSG: Actually it’s $X more a month.

Me: No, I don’t want to pay more. I just want to get the 24Mbps speed I am paying for.

CSG: That’s not something I can help you with.

I confess: I hung up on customer “service” guy. And then I began to ponder how it is that we’ve become a society that fails to take responsibility when problems arise. For every person that steps forward and says, “yep, there’s an issue, let’s figure it out,” another dozen are either ignoring the problem because “fixing” is not part of their jobs, or, quickly placing the blame on someone or something else.

Blame GameAnyone who has worked in IT knows exactly what I mean. A customer’s system goes down and the software folks blame it on the hardware; the hardware guys blame the Internet provider; the Internet provider blames the customer…and so it goes. And no one is happy.

A more tragic example: Thomas Eric Duncan, the first Ebola patient to die in the U.S., went to the ER with stomach pains, fever, and a headache. Despite telling staff he came from Liberia, the information was overlooked by the physician and Duncan was released. By the time he returned to the hospital a few days later, his condition was severe and he eventually died. Between the first and second hospital visits, Duncan could have infected dozens of people – though thankfully that doesn’t seem to have occurred.

When everyone began asking how the hospital could have missed the Ebola diagnosis with the first visit, hospital officials were quick to blame a glitch on the Epic EMR. However, the EMR was apparently just a convenient scapegoat.

After Epic raised a bit of a fuss, the hospital admitted the fault did not, in fact, lie with the EMR. Let’s face it: the hospital PR folks initially blamed the computer because they thought it sounded better than admitting the doctor made a mistake and didn’t fully read the patient record.

And what about the VA’s appointment scheduling scandal?

Several dozen VA facilities apparently kept “secret” waiting lists for veterans waiting to see a doctor while maintaining “official” waiting lists for reporting purposes. Employees were essentially ordered to cook the books to create the appearance that appointments were made within the VA’s 14-days-from-request goal. The secret list scheme continued until a retired VA doctor came forward as a whistleblower. By the time the truth was revealed, dozens of veterans had died before ever seeing a physician; more than 57,000 waited over 90 days to get an appointment.

How many people were aware these lists were being created and maintained? Hundreds? Thousands? Did they remain quiet because they feared losing their job? Didn’t want to get anyone else in trouble? Didn’t think it was their job to say anything?

Maybe the world needs some sort of 12-step recovery program that encourages people to readily admit when there’s a problem, and, encourages more personal responsibility. Seems like a better alternative than practicing avoidance and continuing to allow the buck to stop on someone else’s desk.

Categories: News and Views , All

December 2,2014

10:09

Every November we wish each other a Happy Thanksgiving and express our gratitude for the important things in our lives like friends,  family, and good health. Though we often overindulge in foods that probably aren’t beneficial to our health during this time of year there is one thing you can do this holiday season to promote wellness – gather a family health history.

Since 2004, the U.S Surgeon General has designated Thanksgiving as National Family Health History Day. Health problems like heart disease, cancer and certain genetic issues often run along family lines. Having a family history of a disease often means that family members have an increased likelihood of developing the same illness. However, having a tendency for a disease doesn’t mean that you’re certain to develop it. Often interventions like exercise, diet or medications can help ward off disease and keep an individual healthy. But in order to intervene, patients and their healthcare professionals need to know what they’re up against. So now that you’ve divvied up all your Thanksgiving leftovers, it’s a good time to talk about and write down health issues that run in the family and create a family health history.

It’s never too early to start collecting a family health history. While I was pregnant, I was able to undergo a non-invasive test to see if I was a carrier for genetic abnormalities like Fragile X and Cystic Fibrosis. This was a new test not available a few years ago and it would be wise to have it performed before a woman becomes pregnant so she can be aware of the risks and treatment options.

The CDC encourages pregnant women and those considering pregnancy to know her and the baby’s father’s family health histories to help decrease or discover health issues. The agency says family health histories are valuable in early detection of genetic disorders in children. Young adults can benefit from early screening based on family history.

Both the CDC and National Institutes of Health have guides on how to collect and create a family health history.Recommendations include:

  • Writing down the names of blood relatives in your history. The most important relatives to include are your parents, brothers, sisters, and your children. You many also want to speak with grandparents, aunts and uncles.
  • Ask your family members’ ages and birthdays.
  • Find out if they have any chronic conditions like heart disease or diabetes. Also ask if they have any serious illness or diseases like cancer or stroke and how old they were when they developed an illness.
  • Ask if anyone has had problems with pregnancies or childbirth, or if there are any birth defects or developmental disabilities in the family.
  • Know what countries your family originated from as this can help detect genetic diseases that occur in certain ethnic groups.

This toolkit from Genetic Alliance includes booklets to help you collect a family health history.

To organize and access your family health history you can use the Surgeon General’s web-based tool My Family Health Portrait. It collects your information and creates a “pedigree” that can be downloaded and saved privately. You can share the information with your family and your healthcare provider.

And of course there are apps available to help you curate and save your family health history. Some of these include Capzule, GenieMD, and My Medical Records.

It’s often said that if you don’t have your health, you don’t have anything. Take advantage of the holiday’s family togetherness and get your family health history together.

Categories: News and Views , All

January 6,2014

16:11
GNUmed now supports the following workflow:

- patient calls in asking for documentation on his back pain

- staff activates patient

- staff adds from the document archive to the patient
  export area a few documents clearly related to episodes
  of back pain

- staff writes inbox message to provider assigned to patient

- provider logs in, activates patient from inbox message

- provider adds a few more documents into the export area

- provider screenshots part of the EMR into the export area

- provider includes a few files from disk into export area

- provider creates a letter from a template and
  stores the PDF in the export area

- provider notifies staff via inbox that documents
  are ready for mailing to patient

- staff activates patient from inbox message

- staff burns export area onto CD or DVD and
  mails to patient

- staff clears export area

Burning media requires both a mastering application
(like k3b) and an appropriate script gm-burn_doc
(like the attached) to be installed. Burning onto
some media the directory passed to the burn script
produces an ISO image like the attached.

Karsten
--
GPG key ID E4071346 @ gpg-keyserver.de
E167 67FD A291 2BEA 73BD  4537 78B9 A9F9 E407 1346

November 26,2013

5:10
Here it is

0.) do a full backup. Save it on some other media then your harddisk ! Do it,
now.

1.) Install PG 9.3 ( I tried with 32bit but should not matter).
- http://get.enterprisedb.com/postgresql/postgresql-9.3.1-1-windows.exe

2.) Run the installer and select (English_UnitedStates) for locale (others
might work as well). Make sure it installs itself on port 5433 (or other but
never ! 5432).

3.) Make sure both PG 8.4 and PG 9.3 are running (e.g. via pgadmin3 from PG
9.3)

4.) open a command shell (dos box) - "run as" administrator (!) in Win7

5.) type : RUNAS /USER:postgres "CMD.EXE"
- this will open another black box (command shell) for user postgres
- for the password use 'postgrespassword' (default)

6.) type: SET PATH=%PATH%;C:\Programme\PostgreSQL\9.3\bin;
- instead of Programme it might be Program Files on your computer

7.) type: cd c:\windows\temp
- changes directory to a writable temporary directory

8.) type: pg_dump -p 5432 -Fc -f gnumedv18.backup gnumed_v18

9.) type: pg_dumpall -p 5432 --globals-only > globals.sql

Important : Protect your PG 8.4 by shutting it down temporarly

10.) type in the first command shell : net stop postgresql-8.4
- check that is says : successfully stopped

11.) psql -p 5433 -f globals.sql
- this will restore roles in the new database (PG 9.3 on port 5433)

12.) pg_restore -p 5433 --dbname postgres --create gnumedv18.backup
- this will restore the database v18 into the PG 9.3 on port 5433

Congratulations. You are done. Now to check some things.

########################################
Here you could run the fingerprint script on both databases to check for an
identical hash

https://gitorious.org/gnumed/gnumed/source/f4c52e7b2b874a65def2ee1b37d8ee3fb3566ceb:gnumed/gnumed/server/gm-fingerprint_db.py

########################################

13.) Open gnumed.conf in c:\programme\gnumed-client\
For the profile GNUmed database on this machine ("TCP/IP": Windows/Linux/Mac)]
change port=5432 to 5433.

14. Run the GNUmed client and check that it is working. If it works (no wrong
schema hash detected) you should see all your patient and data.

15. If you have managed to see you patients and everything is there close
GNUmed client 1.3.x.

16.) in the first command shell type: net stop postgresql-9.3

17.) Go to c:\Ptogramme\PostgresPlus\8.4SS\data and open postgresql.conf. Find
port = 5432 and change it to port = 5433

18.) Go to c:\Programme\Postgresql\9.3\data and open postgresql. Find port =
5433 and change it to 5432. This effectively switches ports for PG 8.4 and 9.3
so PG 9.3 runs on the default port 5432.

19.)  Open gnumed.conf in c:\programme\gnumed-client\
For the profile GNUmed database on this machine ("TCP/IP": Windows/Linux/Mac)]
change port=5433 to 5432.

20.) Restart PG 9.3 with: net start postgresql-9.3.

21.) Open the GNUmed client and connect (to PG 9.3 on port 5432).

22.) Leave PG 8.4 in a shutdown state.

So far we have transferred database v18 from PG 8.4 to 9.3. No data from PG
8.4 is touched/lost.

23.) Now you are free to install gnumed-server v19 and gnumed -client 1.4.
Having installed gnumed-server v19 select 'database upgrade' (not boostrap
database) and it will upgrade your v18 database to a v19 database.

In case you experience problems you can always shut down PG 9.3, switch ports again, install client 1.3.x, start PG 8.4 (net start postgresql-8.4) and work with your old setup.

November 13,2013

7:26
The release notes prominently tell us that GNUmed 1.4.x requires at least PostgreSQL 9.1.

If you are running the Windows packages and have let GNUmed install PostgreSQL for you you are good to go since it comes with PostgreSQL 9.2 already.

If you are on Ubuntu or Debian Chances are your system still has PostgreSQL 8.x installed.

First check if you run any software that requires you to continue using PostgreSQL 8.x. If so you can install PG 9.1 side by side with it. If not let PG 9.1 replace PG 8.x

It usually works like this.

sudo apt-get install postgresql-9.1
sudo pg_upgradecluster 8.4 main

Then if you don't need PG 8.4 anymore you could

sudo pg_dropcluster --stop 8.4 main
sudo apt-get purge postgresql-8.4

Have fun.

March 6,2013

11:53

Healthcare executives are continuously evaluating the subject of RFID and RTLS in general.  Whether it is to maintain the hospitals competitive advantage, accomplish a differentiation in the market, improve compliance with requirements of (AORN, JCAHO, CDC) or improve asset utilization and operating efficiency.  As part of the evaluations there is that constant concern around a tangible and measurable ROI for these solutions that can come at a significant price.

When considering the areas that RTLS can affect within the hospital facilities as well as other patient care units, there are at least four significant points to highlight:

Disease surveillance: With hospitals dealing with different challenges around disease management and how to handle it.  RTLS technology can determine each and every staff member who could have potentially been in contact with a patient classified as highly contagious or with a specific condition.

Hand hygiene compliance: Many health systems are reporting hand hygiene compliance as part of safety and quality initiatives. Some use “look-out” staff to walk the halls and record all hand hygiene actives. However, with the introduction of RTLS hand hygiene protocol and compliance when clinical staff enter or use the dispensers can now be dynamically tracked and reported on. Currently several of the systems that are available today are also providing active alters to the clinicians whenever they enter a patient’s room and haven’t complied with the hand hygiene guidelines.

Locating equipment for maintenance and cleaning:

Having the ability to identify the location of equipment that is due for routine maintenance or cleaning is critical to ensuring the safety of patients. RTLS is capable of providing alerts on equipment to staff.

A recent case of a hospital spent two months on a benchmarking analysis and found that it took on average 22 minutes to find an infusion pump. After the implementation of RTLS, it took an average of two minutes to find a pump. This cuts down on lag time in care and can help ensure that clinicians can have the tools and equipment they need, when the patient needs it.

There are also other technologies and products which have been introduced and integrated into some of the current RTLS systems available.

EHR integration:

There are several RTLS systems that are integrated with Bed management systems as well as EHR products that are able to deliver patient order status, alerts within the application can also be given.  This has enabled nurses to take advantage of being in one screen and seeing a summary of updated patient related information.

Unified Communication systems:

Nurse calling systems have enabled nurses to communicate anywhere the device is implemented within the hospital facility, and to do so efficiently. These functionalities are starting to infiltrate the RTLS market and for some of the Unified Communication firms, it means that their structures can now provide a backbone for system integrators to simply integrate their functionality within their products.

In many of the recent implementations of RTLS products, hospital executives opted to deploy the solutions within one specific area to pilot the solutions.  Many of these smaller implementations succeed and allow the decision makers to evaluate and measure the impacts these solutions can have on their environment.  There are several steps that need to be taken into consideration when implementing asset tracking systems:

•             Define the overall goals and driving forces behind the initiative

•             Develop challenges and opportunities the RTLS solution will be able to provide

•             Identify the operational area that would yield to the highest impact with RTLS

•             Identify infrastructure requirements and technology of choice (WiFi based, RFID based, UC integration, interface capability requirements)

•             Define overall organizational risks associated with these solutions

•             Identify compliance requirements around standards of use

Conclusion

RFID is one facet of sensory data that is being considered by many health executives.  It is providing strong ROI for many of the adapters applying it to improve care and increase efficiency of equipment usage, as well as equipment maintenance and workflow improvement. While there are several different hardware options to choose from, and technologies ranging from Wi-Fi to IR/RF, this technology has been showing real value and savings that health care IT and supply chain executives alike can’t ignore.

February 21,2013

14:41

It was not long after mankind invented the wheel, carts came around. Throughout history people have been mounting wheels on boxes, now we have everything from golf carts, shopping carts, hand carts and my personal favorite, hotdog carts. So you might ask yourself, “What is so smart about a medical cart?”

Today’s medical carts have evolved to be more than just a storage box with wheels. Rubbermaid Medical Solutions, one of the largest manufacturers of medical carts, have created a cart that is specially designed to house computers, telemedicine, medical supply goods and to also offer medication dispensing. Currently the computers on the medical carts are used to provide access to CPOE, eMAR, and EHR applications.

With the technology trend of mobility quickly on the rise in healthcare, organizations might question the future viability of medical carts. However a recent HIMSS study showed that cart use, at the point of care, was on the rise from 26 percent in 2008 to 45 percent in 2011. The need for medical carts will continue to grow; as a result, cart manufacturers are looking for innovative ways to separate themselves from their competition. Medical carts are evolving from healthcare products to healthcare solutions. Instead of selling medical carts with web cameras, carts manufacturers are developing complete telemedicine solutions that offer remote appointments throughout the country, allowing specialist to broaden their availability with patients in need. Carts are even interfaced with eMAR systems that are able to increase patient safety; the evolution of the cart is rapidly changing the daily functions of the medical field.

Some of the capabilities for medical carts of the future will be to automatically detect their location within a healthcare facility. For example if a cart is improperly stored in a hallway for an extended period of time staff could be notified to relocate it in order to comply to the Joint Commission’s requirements. Real-time location information for the carts could allow them to automatically process tedious tasks commonly performed by healthcare staff. When a cart is rolled into a patient room it could automatically open the patient’s electronic chart or give a patient visit summary through signals exchanged between then entering cart and the logging device kept in the room and effectively updated.

Autonomous robots are now starting to be used in larger hospitals such as the TUG developed by Aethon. These robots increase efficiency and optimize staff time by allowing staff to focus on more mission critical items. Medical carts in the near future will become smart robotic devices able to automatically relocate themselves to where they are needed. This could be used for scheduled telemedicine visits, the next patient in the rounding queue or for automated medication dispensing to patients.

Innovation will continue in medical carts as the need for mobile workspaces increase. What was once considered a computer in a stick could be the groundwork for care automation in the future.

September 10,2012

9:35

This has been an eventful year for speech recognition companies. We are seeing an increased development of intelligence systems that can interact via voice. Siri was simply a re-introduction of digital assistants into the consumer market and since then, other mobile platforms have implemented similar capabilities.

In hospitals and physician’s practices the use of voice recognition products tend to be around the traditional speech-to-text dictation for SOAP (subjective, objective, assessment, plan) notes, and some basic voice commands to interact with EHR systems.  While there are several new initiatives that will involve speech recognition, natural language understanding and decision support tools are becoming the focus of many technology firms. These changes will begin a new era for speech engine companies in the health care market.

While there is clearly tremendous value in using voice solutions to assist during the capture of medical information, there are several other uses that health care organizations can benefit from. Consider a recent product by Nuance called “NINA”, short for Nuance Interactive Natural Assistant. This product consists of speech recognition technologies that are combined with voice biometrics and natural language processing (NLP) that helps the system understand the intent of its users and deliver what is being asked of them.

This app can provide a new way to access health care services without the complexity that comes with cumbersome phone trees, and website mazes. From a patient’s perspective, the use of these virtual assistants means improved patient satisfaction, as well as quick and easy access to important information.

Two areas we can see immediate value in are:

Customer service: Simpler is always better, and with NINA powered Apps, or Siri like products, patients can easily find what they are looking for.  Whether a patient is calling a payer to see if a procedure is covered under their plan, or contacting the hospital to inquire for information about the closest pediatric urgent care. These tools will provide a quick way to get access to the right information without having to navigate complex menus.

Accounting and PHR interaction: To truly see the potential of success for these solutions, we can consider some of the currently used cases that NUANCE has been exhibiting. In looking at it from a health care perspective, patients would have the ability to simply ask to schedule a visit without having to call. A patient also has the ability to call to refill their medication.

Nuance did address some of the security concerns by providing tools such as VocalPassword that will tackle authentication. This would help verify the identity of patients who are requesting services and giving commands. As more intelligence voice-driven systems mature, the areas to focus on will be operational costs, customer satisfaction, and data capture.

February 5,2013

18:01

[...] medical practice billing software  encourage [...]

December 15,2014

8:44

John Lynn, prolific blogger and health IT media magnate, and I are teaming up again for the second year to produce and deliver a marketing conference focused on helping digital health, health IT, and medical device  innovators. We’re going to be providing actionable advice and specific techniques you can use to cut through the noise when trying to market healthcare and medical tech products to physicians, hospitals, health systems, ACOs, patients, and similar customers. Called The Healthcare IT Marketing Conference, last year’s event covered very important subjects by some of the world’s best experts on those topics and we’ll continue the tradition again in 2015.

Learn the difference between Marketing, Advertising, PR, and Branding

Everyone tells small companies that they need to “do marketing” but that’s really hard to do so I started with a quick visual to explain what it means. It comes from Marty Neumeier on pages 24 and 25 of ZAG by way of the Brand Autopsy Blog (which I highly recommend reading) and illustrates the differences between Marketing, Advertising, PR, and Branding. It’s a wonderful visual and clearly shows that small companies should focus on marketing and free PR, shoot for branding and probably eschew advertising until they have enough money. Our expert speakers at HITMC know the difference and will teach you how to make sure you’re not taking the wrong steps.

Learn how to conduct appropriate market research

Lots of (even innovative) companies don’t do basic market research so we will cover:

  • Find the right search terms for your industry or product. Don’t be esoteric. Because most products will only be found through word of mouth or on the Internet, don’t choose terms to describe yourself that no one else understands. Selling to hospitals is not about creativity, it’s about value. If the customer doesn’t understand what you’re selling give up now.
  • Use competitive intelligence to locate your competitors and existing firms.

Learn about the different kinds of of Business Models to consider

  • Software as a Service (SaaS) and subscription model  — best model for startups with something they can maintain in their own data centers
  • Consulting and Solutions model — when you can provide packaged help
  • Licensed model — when privacy or complexity requires solutions to be installed in house
  • Freemium model (and open source)

Learn about major healthcare industry fallacies

Selling to the healthcare community is very hard and there are many myths that our conference will dispel:

  • Healthcare folks are neither technically challenged nor simple techno-phobes. Because they are in the business of saving lives and improving health, they care about technologies that help them achieve their mission.
  • Most product decisions are no longer made by clinical folks alone, CIOs are fully involved. Don’t try to sell just to the clinical folks — make sure the IT side is engaged and on your side.
  • Complex, full-featured, products are not easier to sell than simple, stand alone tools that have the capability of interoperating with other solutions are much easier to sell. Software as a service is a good approach.
  • Hospitals will not buy unless one proves value. This seems obvious but many companies think that because they think something is important, their customers will just agree.
  • Selling into doctors offices is not easy. There were a few startups looking to sell to individual physicians’ offices. Selling to to your first dozen physicians is pretty easy since we all know doctors. Just be careful, though, since selling to the next dozen and beyond is where companies fall.

Learn how to align the Payers, Beneficiaries, and Users (PBU) of your Health IT or MedTech product

There are three distinct groups you’re marketing and selling your products to:

  • The payer or the person/entity that writes the check for your product.
  • The person or group that benefits most from the use of the product.
  • The person or group that actually uses the product.

I call this the “PBU alignment” problem. In a complex environment like healthcare, the three groups are often not the same — if you can find a market in which the payers, the beneficiaries, and the users are all the same then your sales job is easy. However, that’s commonly not the case. Let’s take a look at the typical example of a complex product like an electronic medical records (EMR) software package in the era of ARRA, HITECH, and meaningful use (MU). The “payer” may ultimately be government reimbursements through  Medicare, the “beneficiaries” are the healthcare insurance firms and the government agencies that need the MU data, and the “users” are the doctors and staff at physicians offices and hospitals. Why has it taken decades for EMRs to be sold to just a tiny fraction of the total industry? Because the PBU alignment hasn’t been reached — until the users, beneficiaries, and payers of the products all understand the value and are willing to work together to achieve a goal it will be tough.

Join us at the conference to talk with experts on the PBU lesson and advice for your product. Figure out the PBU alignment problem and see how you’ll sell to each of the groups and make the right arguments — you do it right and you’ll make money. If you forget the complexities of the PBU and you’ll be languishing, too.

Go home with many tips and tricks:

  • Make sure your company and its value is easy to explain
  • Make sure your value is defendable and differentiated (but without being esoteric)
  • Make sure that you have ability to attract partners and can either create or be part of an ecosystem
  • Ensure that you have word of mouth opportunity
  • Have scaleable staff and systems
  • Have a scaleable product — build once, sell many times
  • Have an uncomplicated pricing and deployment model
  • Be very focused — you can’t “solve healthcare” but you can solve very specific problems
  • Try to own the relationship with and information about customers — don’t rely on partners that won’t give you access to customers

 

November 9,2014

12:50

Earlier this year NueMD created a nice looking Meaningful Use Infographic — asking the question whether MU was helping or hurting EHR Adoption. I loved the summary but I wanted to dig in a little further so I asked Dr. William Rusnak, a resident physician in radiology and a healthcare IT writer for NueMD, to tell us what that infographic meant for innovators and folks building solutions. Here’s what Dr. Rusnak said:

When the Centers for Medicare and Medicaid Services (CMS) launched their Electronic Health Records (EHR) Incentive Programs, coined “Meaningful Use” (MU) back in January 2011, the main goal was to reward healthcare practitioners and administrators for adopting EHRs and increasing efficiency within their practice. NueMD, a medical billing software company, decided to take a closer look at the effectiveness of this program. They compiled research from the Department of Health and Human Services (HHS), CMS, and the American College of Physicians (ACP) looking to identify adoption trends and determine potential obstacles to successful implementation.

The results are quite interesting and have shed some light upon the massive opportunity for technical breakthroughs in healthcare. If tech innovators want to join the movement, they should be continually searching for processes in medicine that still involve some sort of manual transmission of information. Talk to your friends that are nurses, doctors, office managers, billers, or administrators. You would be surprised simply by the amount of information still being written on papers and stuffed in pockets throughout the day!

Adoption, attestation, and a younger generation of physicians

According to a survey of more than 1,200 physicians, EHR adoption is certainly taking place, but when it comes to officially attesting to Meaningful Use – the numbers suggest there’s still room for improvement. Practices with more than 50 physicians had the highest rate of EHR adoption at 85%, with 62% attesting to MU. The big disparity exists among small practices (less than 10 providers) in which half have implemented EHR technology, while only 25% have attested to MU.

This will improve, though. With younger physicians beginning to practice and take on leadership positions, it is very likely that adoption rates will increase substantially over the next decade. In the past, one of the biggest challenges EHR vendors have faced is working with a userbase that wasn’t keen on technology. Soon, however, the majority of practicing physicians will be of the generation that was introduced to technology much earlier in life. Additionally, Medical Economics states that even many older physicians have become comfortable in using technology in their practices, claiming that this age-group has begun to see some of the highest rates of EHR adoption. Thus, the market, not only only for EHR, but also nearly any kind of health technology, is just about ready to surge.

User satisfaction and efficiency, or lack thereof

Although this data suggests EHR adoption is on the rise, providers’ feelings about implementing and using EHRs is showing another trend.  Between March 2010 and December 2012, user satisfaction decreased 13% from 61% to 48% while dissatisfaction rose 14% from 23% to 37%.  What’s to blame? Of those surveyed, 67% claimed system functionality as their primary reason for switching EHR vendors.

One could look at this on the surface and think that since satisfaction is decreasing, healthcare information technology (HIT) is a struggling industry. But, let’s not kid ourselves. HIT is here to stay and most of the gripes and complaints about EHR are typical for any developing technology. If anything, these data suggest that within this storm of inefficiencies exist ample opportunities for improvement. Developers should take this into consideration for future healthcare software. More emphasis needs to be the true effectiveness of the software. This problem could be solved rather quickly with focus groups consisting of healthcare providers. Let them pick apart your software and find bottlenecks, set-backs, and other negative features. In the end, the electronic version of any process must absolutely be less time-consuming than the old-fashioned paper method.

Another very common complaint of many EHR systems is that the usability is far from intuitive. This could be the lowest-hanging fruit in the tree of improvements to this kind of software. Although each user will differ in education — from patient to nurse to physician — all of them should be able to easily access any and all of the health information stored from the patient encounters. Innovators can easily overcome this obstacle by make a significant effort to create simple, user-friendly interfaces. Again, use focus groups or chat with current clients and find out where users struggle with simple tasks. Are there too many unused features on the “home” page? Is there are particular action that users frequently perform, but must search through several menu options to get to it?

The data entry dilemma

The next problem is rather complicated and that is of data entry. Currently, physicians and other providers are using either dictation software or typing to get information into the EHR. Streamlining this process even further will decrease the time necessary for documentation, thus providing more time for the patient interview. Innovators should be looking to try to design alternative ways input information into EHRs.

Since most devices now have voice recognition, an app that could allow physicians to quickly record the patient interview then allow for review and submission into any EHR would be an amazing product. It would be even more impressive if the app could create custom documents and help to avoid repetition. For example, physicians could record physical exam findings while s/he speaks them during the exam. This eliminates some documentation after the interview.

In the future, similar apps for wearables will be even more helpful. Imagine devices, such as otoscopes, thermometers, blood pressure cuffs, and stethoscopes recording data directly into the EHR as you use them. This reality is not too far off and any software that facilitates this data collection is likely to thrive.

Government intervention: Does it help or hurt?

Let’s get back to the question at hand. Is the government’s intervention helping or hurting? Unfortunately, the positive effects of the incentives seemed to have plateaued, given the lower amount of attestations in 2013. Furthermore, in a few rare instances, they have actually indirectly caused some healthcare leaders to commit fraud. A hospital CFO in Texas aided the hospital in receiving $800,000 in MU incentives, yet the system barely used its EHR. He was also reported to commit identity fraud in order to receive MU incentives. Additionally, on the innovation side of things, much of the funding in the form of grants, has run out, leaving most of the HIT companies that received them struggling to sustain themselves.

There are some good points. MU has initiated the transition to EHR for both vendors and providers. It was a surge of development in healthcare. In the process, providers were given software that was quickly designed and lacked key features. Therein lies the opportunity. Innovators now have customers with large demand for features such as usability, interoperability between software packages, and mobile implementation. Even though the EHR space in particular is crowded, there is still room for companies to create better patient portals, educational apps, analytics apps for wearables, and additional software that can be integrated into existing EHRs. And as far as the drought of government funds, venture funding for healthcare start-ups and companies is still plentiful.

Bad news can be good news

Overall, this data should be a wake-up call to everyone in the industry. Hospitals and smaller practices are struggling with the transition to a completely electronic system. Not to mention, they are unable to achieve true interoperability – open communication channels between everyone involved in patient care. However, this massive amount of problems is really a gold mine for HIT entrepreneurs. My advice to these innovators in the industry is to start connecting with physicians (or any other healthcare professional) willing to provide constructive input. Being that kind of doctor myself, I can tell you that I want nothing more than for developers to collaborate with those of us on the front lines of patient care. It’s only going to result in better software and devices.

October 26,2014

14:15

I’ve written a number of articles and a few video interviews on job opportunities in digital health recently and have received a steady stream of questions since then. Given healthcare IT professionals can make $90,000 or more annually, there has been growing interest in the industry. To help separate fact from fiction and dive a little deeper in to the realities of these opportunities, I reached out to Beth Kelly, a freelance writer from Chicago, IL to summarize the projected outlook for specialized positions within the field of health IT. Careers in healthcare IT are appealing whether your preference lies within the computer or medical sciences; what’s clear though is to succeed you’ll need to have your passion fit somewhere between both.  As positions in the industry are constantly evolving, the ability to adapt to new technology is also crucial — whatever is “cool” today will be different tomorrow. As healthcare providers and physicians strive to  implement new technology systems, the expertise of HIT professionals will guide the industry into the future so knowing the Outcome Driven Innovation (OID) and JTBD of clinical professionals will be a differentiator for those who possess such skills. The market for health care information technology continues to show enormous growth potential – with no signs of slowing down any time soon. Here’s what Beth thinks the outlook is:

General Qualifications and Useful Certifications

It’s clear that the expanding field of healthcare IT affords plenty of opportunities. But of course, making the move into this field isn’t as simple as picking up the phone and interviewing. Qualifications are important — in a recent salary survey report completed by HealthITJobs.com, it was noted that certified workers are on average making $10,000+ more than those without certifications.  If you are an IT worker currently, CISSP, CCNA, and PMP are a few technical certifications that are in high demand in Healthcare IT. But beyond the classroom, health IT requires a unique set of skills, and not all of them are related to technology. In healthcare, the right applicant needs to understand more than codes and processes. Many hiring managers look for applicants with “soft skills” who are willing to work in a highly collaborative environment. Applicants for HIT positions need to be aware that in a hospital environment, their position is not the star of the show. Ultimately the healthcare world revolves around the patient, and IT roles provide supportive care. In many cases when hiring, institutions prefer applications with a combination of IT and clinical skills.

Optimizing opportunities afforded by the changing healthcare landscape requires a lot of hard work and insight into the diverse nature of the healthcare IT job market. Whether you are transitioning to IT from a clinician position, or you have an IT background already but are new to healthcare, challenges are inevitable. But in an increasingly digital world, where people use technology in more ways perhaps than they even realize, an HIT skill set is almost guaranteed to pay off.

The healthcare sector of IT is as diverse as the industry itself. There are numerous areas in which to specialize; the following domains being several of the most promising.

Mobile Healthcare

Looking purely at the numbers, Americans are inseparable from their phones. And with nearly one third of all mobile applications being health related, the opportunity to access and utilize vast amounts of health data is there, also. As Silicon Valley tech companies take a greater interest in mobile health devices, advances in analytic software now make it possible to capture illuminating data about our daily lives. The sum of this information is aimed to transform medicine. Even as privacy concerns loom, the ubiquity of smartphones and tablets promises career opportunities in the realm of HIT.

Joseph Hobbs, CIO at Community Hospital at Anderson located in Anderson, Indiana, had this to say about mobile technologies: “This is a huge topic for any organization. Whether it is a mobile cart, a tablet or a smartphone, you need to give caregivers access at their fingertips. The [other] challenge in healthcare is that it’s not a one-size-fits-all initiative. Beyond just finding a solution for all you then have to worry about security and application presentation to all of these types of devices.”

Many health professionals agree that the data from medical devices and data from modern EHR solutions should be integrated. When mobile devices are capable of being linked to EHR, physicians can provide patients with appointment alerts and medication reminders, as well as additional medical assistance. In the remote patient monitoring space, cell service provider Verizon represents the Converged Health Management solution, one of the first products that hopes to bridge the gap between monitoring devices and EHRs. Partnering with Ideal Life, a medical device company, Verizon’s platform is capable of measuring blood pressure, oxygen saturation, glucose levels and weight.

The market for mobile healthcare apps promises many new opportunities for with room tremendous growth and earning potential. According to German market research firm research2guidance, the worldwide market for mobile health applications and their corresponding services reached $2.4 billion in revenue in 2013 and will grow to $26 billion by the end of 2017.

Mobile apps are becoming increasingly significant in the healthcare community, their influence extending throughout both the medical and insurance industries. Mobile app developer positions are in extremely high demand. With medical health app growth ahead of the general mobile market, there are tremendous number of opportunities for people interested in these positions. According to the U.S. Bureau of Labor and Statistics, from the years 2010-2020, there is a projected growth rate of 57.4% for software application developers. For software systems developers, there is a projected growth rate of 71.7%. It’s estimated that overall employment in the industry will continue to grow rapidly.

Clinical Informatics

Clinical analytics are a top priority for two reasons: data mined by those with analytic skill can be used to understand population health, helping better identify infectious disease outbreaks and other population health trends, and can also be used to help a hospital’s bottom line. Big data allows providers to better see how their resources are spent, and where they can trim the fat. The recent deal between Apple and IBM only promises to fuel the market for data analyst positions.

In the current market, an advanced degree in health informatics is very useful. Because of the move toward electronic health records, hospitals and health systems need qualified people to undertake complex projects. A degree opens the door to working for a hospital, a health system, a vendor that sells electronic records or computer software or as a professional consultant. From 2010 to 2020, the U.S. bureau of Labor has said that employment of computer systems analysts in computer systems design and related services will grow 43 percent. Businesses will typically hire them to reorganize IT departments to operate more efficiently.

HIPAA, Meaningful Use and ICD-10 Project Managers

Now that both HIPAA and HITECH are being fully enforced, affected entities can be audited for compliance at any time. At Stage 2 of the HITECH act a certain percentage of provider’s patients must use and interact with patient portals. Navigating HIPAA privacy regulations and the proprietary nature of the portal software is a convoluted process. And the transition from ICD-9-CM to ICE-10-CM is a hefty task as well; ICD-9-CM contains 13,000 3-5-character alphanumeric diagnosis codes with 855 code categories.  ICD-10-CM contains 68,000 3-7-character alphanumeric diagnosis codes with 2,033 code categories. In the transition to greater coding specificity, hospitals typically look for someone who has worked as a coder and in health information management roles.

As health organizations strive toward integrating ICD-10 throughout every aspect of their business, there is an enormous need for medical coding and billing specialists capable of working with the updated diagnostic coding system. ICD-10 skills will put you in the front running for an in-demand position such as project manager, ICD-10 coding specialist, or even ICD-10 educator.

Skills in HIPAA Compliance qualify you for a high level HIPAA Privacy Officer position, a role that typically pays over $60,000 annually. Meaningful Use Director positions, a recent addition to the healthcare landscape, can pay anywhere between $35-80,000 each year.

Privacy and Data Breach Prevention Specialists

Health Information privacy specialists are in extremely high demand. EHR applications, particularly when accessed on mobile devices, require enhanced security access and monitoring. Data breaches are expensive, embarrassing, and damaging to to health groups, but many physicians still neglect to encrypt the patient information they’ve stored on various devices. Healthcare organizations need to take security seriously, and bring on IT professionals to ensure they are doing everything they can to reduce instances of identity theft.

Information security spending is expecting to increase nationwide, especially within industries that deal with sensitive information such as hospitals. New security measures are added and reconfigured constantly, and as a result the demand for privacy and data protection specialists is always high. Job growth for this title is projected to grow upwards of 25% within the next 5-10 years.

Pharmaceutical companies, naturally interested in joining the digital health movement as well, have found it more difficult to gain traction. A 2013 Deloitte survey found that, while people trust doctors and medical professionals the most, they trust companies like WedMD next and then internet search results. Big pharma companies come in dead last. Healthcare organizations and pharma companies are competing, not within their respective sectors, but against one another. Digital pharma is only now beginning to take off. According to M2i2′s Chief Medical Information and Innovation Officer Sachin Jain in a May interview, “the ultimate incentive is that we as a company are gradually finding our way into the outcomes improvement business, as opposed to the pill and vaccine business, and as we do that, I think we realize that data and technology and HIT is going to be a critical enabler.”

Getting started in healthcare IT is not as intimidating as it may seem. For new job seekers, however, it is important to research the different types of positions available and where you may be most helpful. Additionally, for those without a background in health, learning clinical workflows and the other processes that go into healthcare is imperative. Experience, if it’s outside the realm of healthcare, can be transferable, but you will need to be sure to tailor your resume and cover letter around the language of the health industry. If possible, volunteer in a hospital or similar healthcare IT setting to obtain hands-on experience.

Unlike humans, which can handle diversity, computers hate variations. Hospitals and physicians have experienced workflow disruptions and productivity loss as they adopt more advanced EHR systems. Health IT workers, cogs in the digital health machine, fulfill hybrid roles that blend the skills of clinicians and traditional IT workers. As the nature of the healthcare industry continues to evolve, the future for healthcare IT continues to look very bright.

March 12,2010

11:01
This blog is now located at http://blog.rodspace.co.uk/. You will be automatically redirected in 30 seconds, or you may click here. For feed subscribers, please update your feed subscriptions to http://blog.rodspace.co.uk/feeds/posts/default. Rodhttp://www.blogger.com/profile/12607263970096550308noreply@blogger.com0

March 3,2010

4:07
I've just heard about the Information Technology and Communications in Health (ITCH) which will be held February 24 - 27, 2011, Inn at Laurel Point, Victoria, BC Canada.I'd not heard of this conference before but the current call for papers looks interesting.Health Informatics: International Perspectives is the working theme for the 2011 international conference. Health informatics is now a Rodhttp://www.blogger.com/profile/12607263970096550308noreply@blogger.com0
3:59
The report of the Prime Minister’s Commission on the Future of Nursing and Midwifery in England sets out the way forward for the future of the professions which was published yesterday, calls for the establishment of a "high-level group to determine how to build nursing and midwifery capacity to understand and influence the development and use of new technologies. It must consider how pre- and Rodhttp://www.blogger.com/profile/12607263970096550308noreply@blogger.com0

June 9,2013

16:10

“Large collections of electronic patient records have long provided abundant, but under-explored information on the real-world use of medicines. But when used properly these records can provide longitudinal observational data which is perfect for data mining,” Duan said. “Although such records are maintained for patient administration, they could provide a broad range of clinical information for data analysis. A growing interest has been drug safety.”

In this paper, the researchers proposed two novel algorithms—a likelihood ratio model and a Bayesian network model—for adverse drug effect discovery. Although the performance of these two algorithms is comparable to the state-of-the-art algorithm, Bayesian confidence propagation neural network, by combining three works, the researchers say one can get better, more diverse results.

via www.njit.edu

I saw this a few weeks ago, and while I haven't had the time to delve deep into the details of this particular advance, it did at least give me more reason for hope with respect to the big picture of which it is a part.

It brought to mind the controversy over Vioxx starting a dozen or so years ago, documented in a 2004 article in the Cleveland Clinic Journal of Medicine. Vioxx, released in 1999, was a godsend to patients suffering from rheumatoid arthritic pain, but a longitudinal study published in 2000 unexpectedly showed a higher incidence of myocardial infarctions among Vioxx users compared with the former standard-of-care drug, naproxen. Merck, the patent holder, responded that the difference was due to a "protective effect" it attributed to naproxen rather than a causative adverse effect of Vioxx.

One of the sources of empirical evidence that eventually discredited Merck's defense of Vioxx's safety was a pioneering data mining epidemiological study conducted by Graham et al. using the live electronic medical records of 1.4 million Kaiser Permanente of California patients. Their findings were presented first in a poster in 2004 and then in the Lancet in 2005. Two or three other contemporaneous epidemiological studies of smaller non-overlapping populations showed similar results. A rigorous 18-month prospective study of the efficacy of Vioxx's generic form in relieving colon polyps showed an "unanticipated" significant increase in heart attacks among study participants.

Merck's withdrawal of Vioxx was an early victory for Big Data, though it did not win the battle alone. What the controversy did do was demonstrate the power of data mining in live electronic medical records. Graham and his colleagues were able to retrospectively construct what was effectively a clinical trial based on over 2 million patient-years of data. The fact that EMR records are not as rigorously accurate as clinical trial data capture was rendered moot by the huge volume of data analyzed.

Today, the value of Big Data in epidemiology is unquestioned, and the current focus is on developing better analytics and in parallel addressing concerns about patient privacy. The HITECH Act and Obamacare are increasing the rate of electronic biomedical data capture, and improving the utility of such data by requiring the adoption of standardized data structures and controlled vocabularies.

We are witnessing the dawning of an era, and hopefully the start of the transformation of our broken healthcare system into a learning organization.

 

Source: FutureHIT

June 7,2013

13:51

I believe if we reduce the time between intention and action, it causes a major change in what you can do, period. When you actually get it down to two seconds, it’s a different way of thinking, and that’s powerful. And so I believe, and this is what a lot of people believe in academia right now, that these on-body devices are really the next revolution in computing.

via www.technologyreview.com

I am convinced that wearable devices, in particular heads-up devices of which Google Glass is an example, will be playing a major role in medical practice in the not-too-distant future. The above quote from Thad Starner describes the leverage point such devices will exploit: the gap that now exists between deciding to make use of a device and being able to carry out the intended action.

Right now it takes me between 15 and 30 seconds to get my iPhone out and do something useful with it. Even in its current primitive form, Google Glass can do at least some of the most common tasks for which I get out my iPhone in under five seconds, such as taking a snapshot or doing a Web search.

Closing the gap between intention and action will open up potential computing modalities that do not currently exist, entirely novel use case scenarios that are difficult even to envision before a critical mass of early adopter experience is achieved.

The Technology Review interview from which I extracted the quote raises some of the potential issues wearable tech needs to address, but the value proposition driving adoption will soon be truly compelling.

I'm adding some drill-down links below.

Source: FutureHIT
11:22

Practices tended to use few formal mechanisms, such as formal care teams and designated care or case managers, but there was considerable evidence of use of informal team-based care and care coordination nonetheless. It appears that many of these practices achieved the spirit, if not the letter, of the law in terms of key dimensions of PCMH.

via www.annfammed.org

One bit of good news about the Patient Centered Medical Home (PCMH) model: here is a study showing that in spite of considerable challenges to PCMH implementation, the transformations it embodies can be and are being implemented even in small primary care practices serving disadvantaged populations.

Source: FutureHIT

December 4,2014

12:52
individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
group

"All patient and care records digital,
real time and interoperable by 2020."
"Clinicians in primary, urgent
and emergency care, and other key transitions
of care contexts will be operating without paper records by 2018."
"Patients have access to their hospital,
community, mental health and social care services records by 2018."

"By April 2016, commissioners and providers
must publish "road maps" showing how they
will develop interoperable digital records
and services by 2020."


Report: Personalised Health and Care 2020. National Information Board. November 2014.

Source:
Illman, J. (2014) National tech blueprint sets greater role for regulators - Personalised Health and Care 2020: selected recommendations, Health Service Journal, 21 November. 124: 6424; p.13.


Categories: News and Views , All

November 17,2014

18:24
Mike Miliard Editor of Healthcare IT News posted an item:

Pros and cons of pulling behavioral and social data into EHRs

To put my reply in context here is the start of Mike's post:
Should more types of health data figure into electronic health records?

On the one hand, the Institute of Medicine put out a call for doing just that on the grounds that behavioral and social data can benefit population health practices to ultimately improve the care of individual patients. For physicians who already complain that EHRs are burdensome and distract from care delivery, on the other hand, the idea of making electronic records more complex, perhaps even cluttered, will inevitably be unwelcome news. ...

Talk about a work in progress? How long does it take to get this right? Of course health and social care data is always ongoing, as governments change, policy, medicine, local government, social care, technology and society too.

As Mike notes for many physicians the EHR is already burdensome. My context is quite different being nursing, mental health, and crisis-oriented in the community. I've defined small research-based datasets in the past and it is a fascinating pursuit. Trying to have the data defined and reporting ready before the 'door opens'. Doing this retrospectively is no fun at all.

At work when I visit someone in a residential care or nursing home, do I record this as 'home', or 'community' in the absence of the aforementioned categories? Is this ageism?

Is there a digital dividend to come to the physician's aid? Surely increasingly the physical measurements and observations in medicine, surgical... can be automatically captured, disseminated and presented accordingly? Surely, it is possible today to bring in other data as the context changes? If we can autofill on words, we should be able to auto-fill the dataset as context shifts? There are many algorithms out there already 'alive and countin-the-clickin'  in the millisecond

http://www.iom.edu/Reports/2014/EHRdomains2.aspx
IoM report
It seems Mr Miliard is writing about one way to define 'integrated care'?

It isn't just 'public health' though;
it must combine, be inclusive of - 'public mental health'.

The focus of the article is the Institute of Medicine's report:

Capturing Social and Behavioral Domains and Measures in Electronic Health Records: Phase 2


Mike lists eight domains from the report and these are mapped to Hodges' model below:

individual
INTERPERSONAL : SCIENCES
humanistic ------------------------------------------- mechanistic
SOCIOLOGY : POLITICAL
group
educational attainment, stress, depression
physical activity, stress
 

social isolation, intimate partner violence (for women of reproductive age)

financial resource strain,
neighborhood median household income

I've included stress twice as there are at least two forms: anxiety - internal; and environmental - external.
Categories: News and Views , All

October 18,2014

11:54
Call for Articles for a Special Section of Semiotica, the Journal of the International Association for Semiotic Studies on the theme of “Social Representations, ICTs and Community Empowerment”.

This special section will provide an overview of the use of Social Representations Theory (SRT) (Moscovici, 1961), for empowering local communities, with a specific focus on the role of Information and Communication Technologies (ICTs), such as the Internet, desktop and mobile devices, radios, etc.

Interested researchers are invited to submit an abstract proposal (word file) of about 500 words via e-mail.

Abstracts should be accompanied by the following information about each of the authors:
  • Name
  • Position
  • Affiliation
  • Contact Information
The deadline for abstracts submission is November 21st, 2014.

Inquiries and submissions can be forwarded electronically to:

Dr. Sara Vannini
Università della Svizzera italiana, (USI Lugano, Switzerland)
sara.vannini AT usi.ch

More information can be found here:
http://www.newmine.org/call-for-articles-social-representations-icts-and-community-empowerment

Thank you so much for your help!

Sara
Sara Vannini, PhD
Visiting Researcher - TASCHA
Executive Director - NewMinE Lab
PostDoctoral Researcher - BeCHANGE Research Group
sara.vannini.usi AT gmail.com
website: http://www.saravannini.com


My source: ciresearchers AT vancouvercommunity.net

Additional link [pj]: Wikipedia - Social representation
Categories: News and Views , All

October 14,2012

20:05

Image of clipboard with checklist

 

Twitter, like the Internet in general, has become a vast source of and resource for health care information. As with other tools on the Internet it also has the potential for misinformation to be distributed. In some cases this is done by accident by those with the best intentions. In other cases it is done on purpose such as when companies promote their products or services while using false accounts they created.

In order to help determine the credibility of tweets containing health-related content I suggest the using the following checklist (adapted from Rains & Karmikel, 2009):

  1. Author: Does the tweet contain a first and last name? Can this name be verified as being a real person by searching it on the Internet?
  1. Date: When was the tweet sent? If it is a re-tweet when was the original tweet sent?
  1. Reference: Does the tweet reference a source? Is this source reliable?
  1. Statistics: Does the tweet make claims of effectiveness of a product or service using statistics? Are the statistics used properly?
  1. Personal story or testimonials: Does the tweet contain claims from an individual who has used or conducted research on the product or service? Is this individual credible?
  1. Quotations: Does the tweet quote or cite another source of information (e.g. a link) that can be checked? Is this source credible?

Ultimately it is up to the individual to determine how to use health information they find on Twitter or other Internet sources. For patients anecdotal or experiential information shared by others with the same illness may be considered very credible. Others conducting research may find this a less valuable information source. Conversely a researcher may only be looking for tweets that contain reference to peer-reviewed journal articles whereas patients and their caregivers may have little or no interest in this type of resource.

Reference

Rains, S. A., & Karmike, C. D. (2009). Health information-seeking and perceptions of website credibility: Examining Web-use orientation, message characteristics, and structural features of websites. Computers in Human Behavior, 25(2), 544-553.

 

 

 

 

 

June 26,2012

14:35

The altmetric movement is intended to develop new measures of production and contribution in academia. The following article provides a primer for research scholars on what metrics they should consider collecting when participating in various forms of social media.

Twitter

ThinkUp

If you participate on Twitter you should be keeping track of the number of tweets you send, how many times your tweets are replied to, re-tweeted by other users and how many @mentions (tweets that include your Twitter handle) you obtain. ThinkUp is an open source application that allows you to track these metrics as well as other social media tools such as Facebook and Google +. Please read my extensive review about this tool. This service is free.

Bit.ly

You should register with a domain shortening service such as bit.ly, which will provide you with an API key that you can enter into applications you use to share links. This will provide a means to keep track of your click-through statistics in one location. Bit.ly records how many times a link you created was clicked on, the referrer and location of the user. Consider registering your own domain name and using it to shorten your tweets as a means of branding. In addition, you can use your custom link on electronic copies of your CV or at your own web site. This will inform you when your links have been clicked on. You should also consider using bit.ly to create links used at your web site, providing you with feedback on which are used the most often. For example, all of the links in this article were created using my custom bit.ly domain. In addition, you can tweet a link to any research study you publish to publicize as well as keep track of how many clicks are obtained. Bit.ly is a free service.

TweetReach

Another tool to measure your tweets is TweetReach. This service allows you to track the reach of your tweets by Twitter handle or tweet. It provides output in formats that can be saved for use elsewhere (Excel, PDF or the option to print or save your output by link). To use these latter features you must sign up for an account but the service is free.

Buffer

Buffer is a tool that allows you to schedule your tweets in advance. You can also connect Buffer to your bit.ly account so links used can be included in your overall analytics. Although Buffer provides its own measures on click-through counts this can contradict what appears in bit.ly. This service is free but also has paid upgrade options available that provide more detailed analytics.

Web presence

Google Scholar Citation Profile

You can set up a profile with Google Scholar based on your publication record. The metrics provided by this service include a citation count, h-index and i10-index. When someone searches your name using Google Scholar your profile will appear at the top before any of the citations. This provides a quick way to separate your articles from someone else who has the same name as you.

Google Feedburner for RSS feeds

If you maintain your own web site and use RSS feeds to announce new postings you can also collect statistics on how many times your article is clicked on. Feedburner, recently acquired by Google provides one way to measure this. You enter your RSS feed ULR and a report is generate, which can be saved in CVS format.

Journal article download statistics

Many journals provide statistics on the number of downloads of articles. Keep track of those associated with your publication by visiting the site. For example, BioMed Central (BMC) maintains an access count of the last 30 days, one year and all time for each of your publications.

Quora

Other means of contributing to the knowledge base in your field include participating on web-based forums or web sites such as Quora. Quora provides threaded discussions on topics and allows participants to both generate and respond to the question. Other users vote on your responses and points are accrued. If you want another user to answer your question you must “spend” some of your points. Providing a link to your public profile on Quora on your CV will demonstrate another form of contribution to your field.

Paper.li

Paper.li is a free service that curates content and renders it in a web-based format. The focus of my Paper.li is the use of technology in Canadian Healthcare. I have also created a page that appears at my web site. Metrics on the number of times your paper has been shared via Facebook, Twitter, Google + and Linked are available. This service is free.

Twylah

Twylah is similar to paper.li in that it takes content and displays it in a newspaper format except it uses your Twitter feed. There is an option to create a personalized page. I use tweets.lauraogrady.ca. I also have a Twylah widget at my web site that shows my trending tweets in a condensed magazine layout. It appears in the side bar. This free service does not yet provide metrics but can help increase your tweet reach. If you create a custom link for your Twylah page you can keep track of how many people visit it.

Analytics for your web site

Log file analysis

If you maintain your own web site you can use a variety of tools to capture and analyze its use. One of the most popular applications is Google Analytics. If you are using a content management system such as WordPress there are many plug-ins that will add the code to the pages at your site and produce reports. WordPress also provides a built-in analytic available through its dashboard.

If you have access to the raw log files you could use a shareware log file program or the open source tool Piwik. These tools will provide summaries about what pages of your site are visited most frequently, what countries the visitors come from, how long visitors remain at your site and what search terms are used to reach your site.

Summary

All of this information should be included in the annual report you prepare for your department and your tenure application. This will increase awareness of altmetrics and improve our ability to have these efforts “count” as contributions in your field.

June 24,2012

12:52
  1. The following provides a timeline of articles that appeared in newspapers and blogs from January 2011 to present. The articles demonstrate a progress from patient engagement in online communities to those that include reference to increasing provider involvement.
  2. January 5th, 2011
  3. February 3rd, 2011
  4. February 22nd, 2011
  5. March 23rd, 2011
  6. April 2nd, 2011
  7. April 25th, 2011
  8. May 14th, 2011

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